Anemia of Prematurity - Portal Neonatal

In circumstances where volume expansion and vasoactive/inotropic agents have been unsuccessful,
glucocorticoids, such as dexamethasone or hydrocortisone, have been shown to be effective. The
findings that steroids rapidly up-regulate cardiovascular adrenergic receptor expression and serve
as hormone replacement therapy in cases of adrenal insufficiency explain their effectiveness in
stabilizing the cardiovascular status and decreasing the requirement for pressure support in the
critically ill newborn with volume- and pressure-resistant hypotension.
Agents Used to Treat Neonatal Shock
Agent Type Agent Dosage Comments
Volume
expanders
Vasoactive
drugs
Isotonic sodium
chloride solution
10-20 mL/kg IV
Inexpensive,
available
Albumin (5%) 10-20 mL/kg IV Expensive
Plasma 10-20 mL/kg IV Expensive
Lactated Ringer
solution
10-20 mL/kg IV
Isotonic glucose 10-20 mL/kg IV
Inexpensive,
available
Inexpensive,
available
Whole blood products 10-20 mL/kg IV Limited availability
Reconstituted blood
products
Dopamine 5-20 mcg/kg/min IV
Dobutamine 5-20 mcg/kg/min IV
10-20 mL/kg IV Use O neg
Epinephrine 0.05-1 mcg/kg/min IV
Never administer
intra-arterially
Never administer
intra-arterially
Never administer
intra-arterially
Hydralazine 0.1-0.5 mg/kg IV q3-6h Afterload reducer
Isoproterenol 0.05-0.5 mcg/kg/min IV
Never administer
intra-arterially
Nitroprusside 0.5-8 mcg/kg/min IV Afterload reducer
Norepinephrine 0.05-1 mcg/kg/min IV
Never administer
intra-arterially
Phentolamine 1-20 mcg/kg/min IV Afterload reducer
Surgical Care: Structural heart disease or arrhythmias often require specific pharmacologic or
surgical therapy. The liver and bowel may be damaged by shock, leading to gastrointestinal bleeding
and increasing the risk for necrotizing enterocolitis, particularly in the premature infant.
Consultations: Depending upon the type of shock, potential consultants might include the following
pediatric subspecialists: neonatologist, cardiologist, nephrologist, infectious disease specialist, and
hematologist.
Diet: Infants in shock should not be fed, and feedings should not be resumed until gastrointestinal
function has recovered. Initiate total parenteral nutrition as soon as possible.